Biomarkers of outcome from cardiovascular disease

Recognition of the fact that low-grade local and systemic inflammation accompanies all stages of atherogenesis has led to the identification of a number of novel biomarkers of cardiovascular risk. We highlight recent epidemiological and experimental evidence concerning four emerging biomarkers: C-reactive protein, interleukin-6, D-dimer and white blood cell count.

Recent epidemiological and experimental data on C-reactive protein, the most extensively studied marker of systemic inflammation, produced in the liver in response to interleukin-6, has cast some doubt on its clinical utility and causal involvement in atherogenesis. However, a large number of studies still strongly support C-reactive protein as an independent predictor of future cardiovascular risk and a potent proatherogenic agent. Among all markers of inflammation studied to date, C-reactive protein seems the most suitable one for use in clinical practice. Regarding white blood cell count, recent studies focused on the differential leucocyte count in coronary-heart-disease risk assessment; neutrophil count represents the strongest predictor of incident coronary heart disease.

Thus, screening for low-grade inflammation using several novel biomarkers might provide an important tool to identify individuals at increased risk who would benefit most from targeted preventive interventions.